Obama's hybrid approach to healthcare reform will succeed if progressives come together to support smart, incremental improvements in public programs.

By

April 8, 2009

Like Congressman John Conyers and the seventy-four House co-sponsors of his United States National Health Care Act (HR 676); like the thirty-seven state AFL-CIO councils and more than 500 union organizations that have endorsed that legislation; like the American Medical Student Association, the California Nurses Association and the thousands of doctors associated with Physicians for a National Health Program; like 59 percent of the Americans surveyed in January by CBS News and the New York Times, we would prefer to see Congress respond to this country’s healthcare crisis by scrapping a failed for-profit system and replacing it with a comprehensive national health insurance program.

Even President Obama has said, “If I were designing a system from scratch, then I’d probably set up a single-payer system.” We believe that program would work best if it expanded and improved on Medicare to cover everyone. Unfortunately, the political establishment–susceptible as it is to the influence of health insurers–has shown scant inclination to embrace the best cure for what ails our system.

Obama and his Congressional allies are trying instead for a partial cure: expanding public options while maintaining private-sector competition. Many progressives are supporting the public-plan option on pragmatic grounds, pushing for what they see as a politically feasible fallback from single-payer. As J. Lester Feder points out on page 11 of this special healthcare issue, the public plan “may be a crucial cost-containment measure–if it can run more efficiently than private plans, it can force costs down across the system through competition.”

While a public-private hybrid system would represent a step in the right direction, it is not without its pitfalls. As David Himmelstein and Steffie Woolhandler explain on page 14, Massachusetts, which adopted such a model in 2006, is not providing universal, affordable care to state residents.

Single-payer advocates, meanwhile, are organizing on behalf of Conyers’s HR 676 and variations offered by Washington Democrat Jim McDermott in the House and Vermont independent Bernie Sanders in the Senate. But recognizing the urgency so poignantly detailed by Kate Michelman in her piece in this issue, progressives can also back smart, if incremental, reforms that strengthen and expand publicly funded and managed healthcare–like the legislation advanced by Wisconsin Representative Tammy Baldwin, among others, which would make it easier to develop single-payer systems at the state level.

Let’s repair and fully fund existing public models, like the system of hospitals and clinics that are supposed to care for our veterans. Let’s expand our network of public health clinics, as Sanders has suggested. Let’s look for ways to move more Americans into the Medicare program. In the initial stages of the stimulus debate, there were discussions about lowering the age of eligibility for Medicare as a strategy for aiding Americans younger than 65 who have lost their jobs and health benefits. Perhaps, at the same time, we can merge the S-CHIP program, which serves children, into Medicare.

We should keep in mind that Canada’s system developed over more than twenty years, beginning in the provinces and then going national. While resisting initiatives that use “reform” to strengthen the hand of private insurers, progressives can achieve short-term changes that boost the public side of the equation–and then build on those changes to achieve the comprehensive reform that we need.